Nkhanza za Neurontin pa Kuphuka

Neurontin ali ndi mwayi waukulu kwambiri wochitira nkhanza kuposa momwe ankaganizira kale

Kwa zaka zambiri, madokotala ankawona Neurontin (gapapentin) ndi Lyrica (pregabalin) ngati mankhwala osagwiritsidwa ntchito molakwa. Komabe, kafufuzidwe kafukufuku akusonyeza kuti mankhwalawa nthawi zambiri amagwiritsidwa ntchito molakwika ndi kuzunzidwa.

Mu kafukufuku wa May 2017 wofalitsidwa mu Pharmacoepidemiology ndi Safety Drug , Buttram ndi alembi olemba amatsindika njira yatsopano yovuta. Zakhala zikuwonjezeka ku Neurontin diversion, ndipo kusokoneza kumeneku kukugwirizana ndi mliri wa opioid womwe ukuwononga mbali zambiri za United States.

Anthu akukwera pamtundu wina wa Neurontin ndi opioids (monga, hydrocodone ndi oxycodone).

Olemba a phunziroli amalemba zotsatirazi:

Deta yolondola imasonyeza kuti Neurontin akugwiritsidwa ntchito molakwika pamodzi ndi mankhwala odzoza mavitamini ndi Neurontin ndi heroin akuphatikizidwa ndikugwiritsidwa ntchito palimodzi. Olemba nkhani za malamulo adapeza kuti kugwiritsa ntchito mankhwalawa kumapangitsa kuti Neurontin asatengeke.

Neurontin ndi Lyrica

Poona kuti pali zowawa zopweteketsa komanso zovuta, Neurontin ndi Lyrica amakonda kumwa mankhwala pakati pa madokotala oyamwitsa. Mankhwalawa ndi othandiza kwambiri pochiza matenda aakulu kuposa Advil kapena Tylenol. Komanso, kudalira opioid ndi mliri; motero, opioids ngati Norco kapena Vicodin amagwiritsidwa ntchito pokhapokha kupweteka kowawa kwambiri. Mwa kuyankhula kwina, Neurontin ndi wamphamvu kuposa chinachake chimene mungapeze mu sitolo ya mankhwala ndi zosaopsa kuposa opioids.

(Heroin ndi mtundu wa opioid.)

Momwe Neurontin ndi Lyrica Akugwirira Ntchito

Neurontin poyamba inakonzedwa mu 1977 monga anzanu a GABA. Patatha pafupifupi zaka khumi, Lyrica, msuweni wa mankhwala a Neurontin, anapangidwa. Neurontin inavomerezedwa ndi FDA mu 1993. Pofika mu 2004, Lyrica anagulitsa.

Neurontin ndi Lyrica onse amatchulidwa kuti gabapentinoids ndikuchita zofanana.

Ngakhale kuti zonsezi zinayamba kupweteka, mankhwalawa amadziwika kuti ndi opweteka kwambiri omwe amatha kupweteka kwambiri ndipo nthawi zambiri amalembedwa kuti athetse mavuto osiyanasiyana komanso osamva bwino.

GABA, yoperewera kwa gamma-aminobutyric asidi, ndi mankhwala osokoneza ubongo, omwe amagawidwa mu ubongo wa chiberekero, kapena mbali yina ya ubongo yomwe imayambitsa ubongo wapamwamba. GABA imachita ntchito zosiyanasiyana mu ubongo, kuphatikizapo kuyendetsa galimoto ndi masomphenya komanso kuyendetsa nkhawa ndi ululu.

Ngakhale kuti poyamba ankafuna kupita ku GABA amalandirira mu ubongo, gabapentinoids sichimangiriza kwa GABA receptors. Komanso, sizimangirira kuti zikhale zotsekemera, opioid, kapena benzodiazepine. Ngakhale kuti mankhwala osokoneza bongowa sakanatha kufotokozedwa bwinobwino, zikuwoneka kuti mankhwalawa amachititsa kuti mankhwalawa asokonezedwe komanso athandizidwe kwambiri. Komabe, ma gabapentinoids amatha kuwonjezera kukula kwa GABA ndi kuchepa kwa ubongo mu ubongo.

Neurontin ndi Lyrica amagawana mafotokozedwe ofanana amatsenga, onse amasokonezeka ndi impso ndipo samagwirizana ndi mankhwala ena (mwachitsanzo, kuchepa kwa chiopsezo cha mankhwala osokoneza bongo). Kusiyana kwakukulu pakati pa mankhwalawa ndi bioavailability yawo, kapena kuchuluka kwa mankhwala omwe amachititsa kuti ayambe kufalikira.

Mwachindunji, Lyrica ali ndi bioavailabilty yoposa ya Neurontin ndipo imathamanga mwamsanga komanso yowonjezera. Kusiyanasiyana kumeneku kwachititsa akatswiri ena kuganiza kuti Lyrica ali ndi mphamvu zowononga, ndipo nkhani zotsutsana nazo zimathandizira izi. Komabe, mutengedwako mlingo wokwanira, mankhwala onsewa amachitapo kanthu mwamsanga, ndipo onsewo amachitiridwa nkhanza komanso osagwiritsidwa ntchito molakwika.

Ntchito zachipatala za Neurontin ndi Lyrica

Gabapentinoids ali ofanana pakati pa zotsatira zachipatala.

Mapiritsi a Neurontin, makapulisi, ndi mankhwala ovomerezeka amavomerezedwa ndi FDA kuti (1) azitenga mwakachetechete ndipo (2) azikhala ndi mankhwala osokoneza bongo.

Ku Ulaya, Neurontin amavomerezedwa kuti adziwe kupweteka kwa mtima.

Lyrica imavomerezedwa ndi a FDA kuti amuthandize (1) mankhwala osokoneza ubongo a neuralgia, (2) matenda a shuga wodwala matendawa, (3) fibromyalgia, ndi (4) kugwidwa. Ku Ulaya ndi ku Japan, Lyrica amavomereza kuti amve ululu wa m'mimba komanso matenda ovutika maganizo.

Neurontin sichiyendetsedwa ngati chinthu cholamulidwa ndi boma la US, ndipo mankhwalawa ndi otetezeka kuposa ena a antiticulants. Pulogalamu yotetezekayi yakhala ikugwiritsanso ntchito mankhwala a Neurontin ngakhale kuti akuvutika ndi mayesero a kachipatala kuti athandizidwe.

Pakati pa 83 peresenti ndi 95 peresenti ya malonda a Neurontin. Nawa ena amagwiritsira ntchito mankhwalawa a Neurontin:

• Mowa, benzodiazepine, chamba, ndi opioid withdrawal syndrome
• Chisamaliro chosowa mtendere
• Matenda a bipolar
• Matenda opweteka a m'deralo
• Matenda a shuga
• Kutentha kumatentha
• Mutu wa mutu wa Migraine
• Matenda a ubongo
• Kusokonezeka kwa miyendo nthawi zonse kwa kugona
• Matenda a miyendo yopanda chilema
• Trigeminal neuralgia

Ngakhale kuti DEA imapanga Lyrica ngati mankhwala a Pulogalamu V, posonyeza kuti angathe kugwiritsira ntchito nkhanza kwambiri, akadakali ndi mankhwala oyenera. Izi zikuphatikizapo mfundo yakuti Lyrica ndi yokwera mtengo kuposa momwe Neurontin akufotokozera chifukwa chake Neurontin imatchulidwa kwambiri.

Pomalizira, madokotala ambiri amapereka Neurontin mmalo mwa Lyrica chifukwa Neurontin ndi wotchipa. Lyrica ndi mankhwala odula kwambiri. Chifukwa mankhwala onsewo ali ndi zotsatira zofanana, ndibwino kwambiri kupita ndi njira yotsika mtengo.

Nkhanza za Neurontin Zofotokozedwa

Kusagwiritsira ntchito molakwika ndi kugwiritsa ntchito mowa mopitirira muyeso ndizosiyana, ndipo kusiyana kuli mwa cholinga.

Malinga ndi a FDA: "Munthu akamalandira mankhwala ovomerezeka mwalamulo popanda cholinga chake, kapena ngati munthuyo atenga mankhwala osamuyitanitsa, ndiko kugwiritsa ntchito molakwika mankhwala."

Kugwiritsa ntchito mankhwala osokoneza bongo ndi njira yapadera yogwiritsa ntchito molakwika. Zimachitika pamene anthu amamwa mankhwala osokoneza bongo kuti adziwe "mwakuya," kapena amamva bwino. Ponena za Neurontin ndi Lyrica, kudabwitsa kumeneku kwafotokozedwa m'njira zosiyanasiyana ndipo kukumbukira zotsatira za opioids, benzodiazepines, ndi psychedelics.

Madokotala ambiri amapereka Neurontin kwa mitundu yonse ya zinthu, kuphatikizapo kupweteka, matenda a maganizo, ndi mavuto osokoneza bongo; ambiri a madokotalawa mwina sakudziwa kuti mankhwalawa akhoza kuthetsa nkhanza. Chifukwa chakuti zimapezeka zambirimbiri, ndipo zimakhala zotsika mtengo komanso zosavuta kuzipereka kuposa Lyrica-yomwe ili ndi mankhwala olamulidwa-Neurontin yakhala mankhwala ozunguza kwambiri omwe anthu amawafuna mofulumira kwambiri. Kuwonjezera pamenepo, anthu omwe ali ndi matenda osokoneza bongo komanso matenda a maganizo amatha kugwiritsa ntchito mankhwala osokoneza bongo. Mwa kuyankhula kwina, Neurontin kaŵirikaŵiri imaperekedwa kwa anthu omwe amasonyeza kuti akuzunzidwa kwambiri.

Osati aliyense amene amachitira nkhanza Neurontin-komanso kawirikawiri Lyrica-ali ndi malamulo a mankhwalawa. Kusokonezeka ndi bizinesi yaikulu kwa ogulitsa mankhwala osokoneza bongo, ndipo mosakayikira mankhwalawa amapita kumsewu. Pakati pa 40 peresenti ndi 65 peresenti ya anthu amene amagwiritsa ntchito molakwa Neurontin ali ndi malamulo a mankhwala.

Lipoti la 2012 linati chiwerengero cha Lyrica ndi Neurontin chinawonjezeka ndi 350 peresenti ndi 150 peresenti, pa zaka zisanu zapitazi.

Zindikirani, anthu ena omwe atumizidwa Neurontin amangogwiritsa ntchito mankhwalawa molakwika pofuna kuyesa kudziletsa okha. Anthu ena amagwiritsanso ntchito mankhwalawa molakwika ngati njira yodzivulazira. Komanso, anthu amazunza mankhwalawa pozunza zinthu zina, monga opioids, mowa, ndi benzodiazepines.

Mu 2010, kafukufuku woyamba adawonetsa kuti chiopsezo cha Lyrica chikugwiritsidwa ntchito. Pambuyo pake, European Union inawonjezera mankhwala awa ku mndandandanda wa zinthu zosangalatsa zosangalatsa. Pakati pa 2010 ndi 2016, kafukufuku wazaka khumi ndi ziwiri akhala akuyesa kuthetsa nkhanza za Neurontin ndi Lyrica.

Nazi zina zenizeni zokhudzana ndi kugwiritsa ntchito molakwa za Neurontin ndi Lyrica. Zotsatirazi zimachokera kufukufuku waposachedwapa.

• Kafukufuku wina akusonyeza kuti kuchuluka kwa nkhanza za Neurontin ndi Lyrica kwa anthu omwe amakhala ku UK a zaka za pakati pa 16 ndi 59 ndi 1,1% ndi 0,5 peresenti. Malingana ndi kafukufukuyu, kuchuluka kwa nkhanza zadynabis ndi 28.1 peresenti komanso kugwiritsa ntchito mankhwala osokoneza bongo kwa cocaine ndi 8.1 peresenti. Mwa kuyankhula kwina, mwa anthu omwe alibe vuto la kugwiritsira ntchito mankhwala kapena matenda a m'maganizo, chiwerengero cha gabapentinoid mowagwiritsa ntchito mocheperapo kuposa mankhwala ena achikhalidwe.
• Mwa anthu omwe ali ndi vuto la opioid, chiwerengero cha nkhanza za Neurontin chinali pakati pa 15 peresenti ndi 22 peresenti. Ngakhale, chiŵerengero cha Lyrica chogwiritsira ntchito molakwika pakati pa mamembala a anthu omwewo anali osiyana kwambiri: pakati pa 3 peresenti ndi 68 peresenti. Kwachidziwikire, anthu omwe ali ndi vuto la kugwiritsira ntchito mankhwala akuwoneka ngati akuzunza gabapentinoids pa mitengo yofanana ndi mankhwala ena.
• Ambiri a ku America omwe amagwiritsa ntchito mankhwala osokoneza bongo, chiwerengero cha nkhanza za Neurontin chinali kawiri kawiri ka nkhanza za amphetamine komanso zofanana ndi clonazepam (mtundu wa benzodiazepine) molakwika.
• Ku Scotland, anthu 22 pa anthu 100 alionse amene anapita kumapatala a methadone ankazunza Neurontin.
• Phunziro la 2015 linawonetsa kuti kusokoneza mtendere kwa Neurontin kukuwonjezeka mofulumira. Mwachindunji, pakhala kuwonjezeka kwa 2950 peresenti ya nkhanza kuyambira 2008.
• Zomwe zimagwiritsidwa ntchito pogwiritsa ntchito mankhwala osokoneza bongo zikusonyeza kuti Lyrica ikuyankhidwa pamayeso apamwamba kuposa momwe akulimbikitsiridwira, zomwe zingayambitse nkhanza.
• Kafukufuku wina amasonyeza kuti anthu omwe amachitira nkhanza gabapentinoids amakhala amphongo (30-ish) ndi ndalama zochepa. Komabe, deta yokhudzana ndi chikhalidwe ndi nkhanza ikutsutsana.
• Malingana ndi deta ya deta ya deta "yomwe imachokera ku kafukufuku wam'mbuyomu wa mankhwala osokoneza bongo
  Zomaliza zotsatiridwa ndi malamulo a boma ndi mabungwe oyendetsera ntchito omwe amagwiritsa ntchito mankhwala osokoneza bongo, "Chigwirizano ndi anzawo adapeza kuti kuchuluka kwa ndalama zowonongeka kuchokera ku zero m'zaka ziwiri zoyambirira za 2002 kufika pamtundu waukulu wa 0.027 pa anthu 100,000 omaliza Pakati pa 2015.
• Kusokonezeka kwa Neurontin kumawonekera kukhala wamba Mu ndende za US.

Zotsatira Zina Kuposa Kuposa

Kuphatikiza apo, anthu omwe amazunza gabapentinoids pa supratherapeutic, kapena apamwamba kuposa mlingo woyenera, amafotokozanso zotsatira zina monga zotsatirazi:

• Wokhutira
• Kupuma
• Kusokonezeka
• Kulimbitsa ubwenzi
• Chifundo
• Khalidwe losavomerezeka
• Zojambula zamakono ndi zojambula

Zindikirani, zotsatirazi zikuwoneka zikusiyana chifukwa cha kulekerera ndi mlingo. Kuonjezera apo, kusiya mwadzidzidzi kwa gabapentinoids kungabweretse kukhumudwa kwa kudalira thupi. Komanso, anthu kuchoka ku gabapentinoids angakhalenso ndi zilakolako zamaganizo.

Ngozi za Gabapentinoid Overdose

Pogwiritsidwa ntchito monga mwalembedwera, Neurontin ndi Lyrica ndi okonzeka bwino. Zoipa zimakhala zofatsa ndipo zimaphatikizapo kugona, kusasamala, ataxia, chizungulire, ndi kutopa.

Mosiyana ndi mankhwala ena osokoneza bongo, ngakhale pamene mankhwalawa amatha kuwonjezereka, magabapentinoids amachititsanso zotsatira zochepa chabe, monga kuthamanga kwambiri kwa magazi, kuchuluka kwa mtima, ndi zotsatira zina zofanana ndi zomwe zimawonedwa ndi mankhwala ochiritsira. Gabapentinoid overdose kawirikawiri samafuna hospitalization ndipo palibe kufa chifukwa cha overdose zafotokozedwa. Anthu omwe amadzipiritsa zowonongeka nthawi zambiri amabwerera kuyambalo yoyambira pambuyo pa maola khumi.

Ntchito Udokotala Amene Amachita

Zingakhale zophweka kuika mlandu wa gabapentinoid, kugwiritsa ntchito molakwa, komanso kudalira pa mapewa olemba madokotala. Zedi, mankhwalawa ndi mankhwala okhaokha ndipo motero amatha kubwereranso kwa madokotala okha; Komabe, tiyenera kumvetsetsa kuti anthu omwe amapereka chithandizo ali ndi mwayi wotani pamene wodwalayo akudandaula chifukwa cha ululu ndi mavuto omwe amapweteka kwambiri.

Mwachitsanzo, zimakhala zofala kwa odwala omwe ali ndi matenda a ubongo ndi mitundu ina ya ululu wosatha komanso zowawa kuti amve ululu umene ungamudodometse munthu popanda zikhalidwe. Pamene munthu alowa mu ofesi ya dokotala akudandaula za kuyaka pamapeto pake, kumverera "kuyenda pa galasi" ndi zina zotero, madokotala alibe zofunikira zochizira zizindikiro zoopsya izi, ndipo Neurontin kapena Lyrica ndizo zokha zokha zomwe mungachite.

Madokotala ayenera kuyang'ana zizindikiro kuti wodwala akugwiritsa ntchito molakwa mankhwalawa kapena kugwiritsa ntchito mankhwala osokoneza bongo kapena akukonzekera kuchita zinthu monga zotsatirazi:

• Odwala omwe ali ndi matenda opatsirana pogwiritsa ntchito mankhwala kapena mankhwala ogwiritsira ntchito mankhwala ayenera kuyang'anitsitsa mosamala chifukwa cha nkhanza kapena kusokonezeka.
• Zisonyezero za nkhanza zikuphatikizapo wodwala akufunsa Neurontin kapena Lyrica makamaka, kuti apite mlingo waukulu kuposa momwe akufunira, kapena kuti malamulo ena angapo panthawi yochepa.
• Madokotala ayenera kutsimikiza kuti odwala sali "ogula" kapena kulandira mankhwala ambiri kuchokera kwa anthu ambiri. Chifukwa chofala cha khalidweli ndi chakuti mankhwalawa "adatayika" kapena "akubedwa."
• Dokotala ayenera kulingalira kupanga chojambula cha mankhwala a mkodzo (UDS) kwa odwala omwe amawoneka kuti akutsutsa. Ngati odwalawa akulandira mankhwala a gabapentinoids koma mankhwalawa sapezeka mu mkodzo, ndiye kuti mankhwalawa amapezeka m'misewu.

Mawu Ochokera

Ngakhale zikuwonjezeka, kuchitiridwa nkhanza kwa Neurontin ndi Lyrica kumakhudzanso odwala ocheperapo chabe, ndipo makamaka omwe amawazunza, monga anthu omwe amadalira opioid. Komanso, ngakhale panthawi yowonjezereka, zotsatira za mankhwalawa zimakhala zochepa komanso zochepa-zimakhala zovuta kwambiri chifukwa cha kudalira kwa opioid, mowa, ndi benzodiazepine (zomwe mankhwalawa amagwiritsidwa ntchito pochiritsira).

Ngati inu kapena wokondedwa wanu mutenga mankhwala awa kuti mukhale ndi ululu wodabwitsa kapena wosasangalatsa, ndipo mankhwalawa amapereka mpumulo, ndiye mankhwalawa akugwiritsidwa ntchito monga momwe anafunira. Komabe, kuti muchepetse chiopsezo chanu chochitira nkhanza, nkofunika kuti muyang'ane mosamala ndi dokotala wanu ndipo mutenge mankhwala awa pokhapokha muyezo woyenera. Kumvetsetsa momwe amagwirira ntchito kungathandizire. Komanso, musamamwe mankhwalawa kuti mukhale "otsika," osakaniza mankhwalawa ndi mowa, benzodiazepines, opioids, kapena mankhwala osokoneza bongo, ndipo musapereke kapena kugulitsa mankhwalawa kwa ena.

Ngati nonse muli ndi mafunso okhudza mankhwala omwe mukugwiritsira ntchito-makamaka mankhwala ndi nkhanza zomwe mungachite-chonde funsani dokotala wanu. Dokotala wanu akhoza kutenga nthawi kuti akambirane za ubwino ndi zopindulitsa za mankhwala alionse omwe mwawapatsa. Kuphatikizanso apo, mukhoza kufunsa wamankhwala wanu za mankhwala omwe mwalangizidwa. Monga wodwala, ndiwe ufulu wanu kuti mudziwe za mankhwala omwe mukuwatenga.

> Zotsatira:

> Kulimbana ndi kugwiritsa ntchito molakwa ndi kugwiritsa ntchito mankhwala osokoneza bongo: Q & A ndi Michael Klein, Ph.D. July 28, 2010. www.fda.gov.

> Evoy KE, Morrison MD ndi Saklad SR. "Kugwiritsa ntchito molakwika ndi kugwiritsa ntchito molakwa Pregabalin ndi Gabapentin." Mankhwala osokoneza bongo . 2016.

> Mack A. Kusanthula Umboni Wotsutsa Kugwiritsa Ntchito Gabapentin. Journal of Managed Care Care Pharmacy . 2003; 9: 559-568.

Smith Smith, Havens JR, ndi Walsh SL. "Gabapentin kugwiritsa ntchito molakwa, kuponderezana ndi kusokoneza: ndondomeko yowonongeka." Kuledzera . 2016; 111: 1160-1174.

> Tcheremissine, OV, ndi Bestha DP. Kuzunzika kwa Gabapentin kwa Odwala Ndi Matenda Okhalitsa ndi Matenda Ogwiritsira Ntchito. Zowonjezera mu chipatala . 2016; 13: 13-14.